Are Patient Decision Aids Used in Clinical Practice after Rigorous Evaluation? A Survey of Trial Authors

Abstract

Background. Patient decision aids (PtDAs) are effective interventions to support patient involvement in health care decisions, but there is little use in practice. Our study aimed to determine subsequent PtDA use in clinical practice following published randomized controlled trials. Design. A descriptive study using an e-mail-embedded questionnaire survey targeting authors of 133 trials included in Cochrane Reviews of PtDAs (106 authors). We classified PtDA level of use as a) implementation, defined as integrating within care processes; b) dissemination to target users with planned strategies; and c) diffusion, defined as passive, unplanned spread. We conducted content analysis to identify barriers and enablers guided by the Ottawa Model of Research Use. Results. Ninety-eight authors responded (92.5%) on 108 trialed PtDAs. Reported levels of use were implementation ( n = 29; 28%), dissemination to target user(s) ( n = 9; 9%), and diffusion ( n = 7; 7%); 57 (55%) reported no uptake, and 1 had no response (1%). Barriers to use in clinical practice were identified at the level of researchers (e.g., lack of posttrial plan), PtDAs (e.g., outdated, delivery mechanism), clinicians (e.g., disagreed with PtDA use), and practice environment (e.g., infrastructure support; funding). Enablers were online delivery, organizational endorsement (e.g., professional organization, charity, government), and design for and integration into the care process. Limitations. Self-report bias and potential for recall bias. Conclusions. Only 44% of PtDA trial authors indicated some level of subsequent use following their trial. The most commonly reported barriers were lack of funding, outdated PtDAs, and clinician disagreement with PtDA use. To improve subsequent use, researchers should codesign PtDAs with end users to ensure fit with clinical practice and develop an implementation plan. National systems (e.g., platforms, endorsement, funding) can enable use.

Qualitative analysis of clinicians’ perspectives on the use of a computerized decision aid in the treatment of psychotic disorders

“…For most clinicians it became easier to integrate the feedback of ROM-results into their consultations with patients. This is an important nding, as previous research has shown that CDAs that are di cult to integrate in existing care processes are not used by clinicians after the experimental introduction, subsequently preventing successful implementation (4).…”

“…Despite the effectiveness of these tools (2), their integration in daily clinical practice remains limited (3,4). Less than half of all CDAs are still used after the experimental evaluation period (4). This is due to a lack of funding or endorsement by organizations, because the tools are out of date or do not t the existing care processes (4).…”

Chronic Disease Decision Making and “What Matters Most”

“…Designed to address single decisions, the development and use of multiple aids would be required to inform a plan of care for patients with multiple conditions. However, it has been difficult to achieve the adoption of even single DAs into clinical practice, with a recent study demonstrating that only a minority of aids that are shown to be efficacious in randomized controlled trials (RCTs) are used in clinical practice following trial completion . The most successful implementation strategy appears to be when the decision can be anticipated ahead of time and the patient works through the aid outside of the clinical encounter .…”

“…However, it has been difficult to achieve the adoption of even single DAs into clinical practice, with a recent study demonstrating that only a minority of aids that are shown to be efficacious in randomized controlled trials (RCTs) are used in clinical practice following trial completion. 13 The most successful implementation strategy appears to be when the decision can be anticipated ahead of time and the patient works through the aid outside of the clinical encounter. 14 Such aids are best suited for decisions with robust data regarding probable outcomes.…”

Qualitative analysis of clinicians’ perspectives on the use of a computerized decision aid in the treatment of psychotic disorders

“…evaluation period (4). This is due to a lack of funding or endorsement by organizations, because the tools are out of date or do not t the existing care processes (4).…”